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ADDITIONAL COVERAGES <br />Ref # <br />Description <br />Abuse/Molestation Occ. <br />Coverage Code <br />Form No. <br />Edition Date <br />Limit 1 <br />1,000,000 <br />Limit 2 <br />Limit 3 <br />Deductible Amount <br />Deductible Type <br />Premium <br />Ref # <br />Description <br />Medical Expense <br />Coverage Code <br />MEDEX <br />Form No. <br />Edition Date <br />Limit 1 <br />5,000 <br />Limit 2 <br />Limit 3 <br />Deductible Amount <br />Deductible Type <br />Premium <br />Ref # <br />Description <br />Uninsured motorist combined single limit <br />Coverage Code <br />UMCSL <br />Form No. <br />Edition Date <br />Limit 1 <br />300,000 <br />Limit 2 <br />300,000 <br />Limit 3 <br />Deductible Amount <br />Deductible Type <br />Premium <br />Ref # <br />Description <br />Hired/borrowed <br />Coverage Code <br />HRDBD <br />Form No. <br />Edition Date <br />Limit 1 <br />1,000,000 <br />Limit 2 <br />Limit 3 <br />Deductible Amount <br />Deductible Type <br />Premium <br />$1.00 <br />Ref # <br />Description <br />Coverage Code <br />Form No. <br />Edition Date <br />Limit 1 <br />Limit 2 <br />Limit 3 <br />Deductible Amount <br />Deductible Type <br />Premium <br />Ref # <br />Description <br />Coverage Code <br />Form No. <br />Edition Date <br />Limit 1 <br />Limit 2 <br />Limit 3 <br />Deductible Amount <br />Deductible Type <br />Premium <br />Ref # <br />Description <br />Coverage Code <br />Form No. <br />Edition Date <br />Limit 1 <br />Limit 2 <br />Limit 3 <br />Deductible Amount <br />Deductible Type <br />Premium <br />Ref # <br />Description <br />Coverage Code <br />Form No. <br />Edition Date <br />Limit 1 <br />Limit 2 <br />Limit 3 <br />Deductible Amount <br />Deductible Type <br />Premium <br />Ref # <br />Description <br />Coverage Code <br />Form No. <br />Edition Date <br />Limit 1 <br />Limit 2 <br />Limit 3 <br />Deductible Amount <br />Deductible Type <br />Premium <br />Ref # <br />Description <br />Coverage Code <br />Form No. <br />Edition Date <br />Limit 1 <br />Limit 2 <br />Limit 3 <br />Deductible Amount <br />Deductible Type <br />Premium <br />Ref # <br />Description <br />Coverage Code <br />Form No. <br />Edition Date <br />Limit 1 <br />Limit 2 <br />Limit 3 <br />Deductible Amount <br />Deductible Type <br />HortaN RiskMmRgementDivis <br />REVIEWED & APPROVED <br />3 r, <br />OFADTLCV C <br />Risk Management Analyst <br />